Case Study Analysis

Case Study Analysis

Priority Nursing Diagnoses for Jimmy

The priority nursing diagnoses include acute pain related to stress and anxiety, trauma secondary to head injury, muscle spasms, edema, a fractured left femur, and post-ORIF. Secondly, impaired physical mobility is related to tissue injury, fracture, post-ORIF, and immobilization.

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Priority Nursing Interventions

Priority nursing interventions include continued monitoring of the vital signs to assess for any changes in the BP, heart rate, and SpO2; elevation and support of the left limb are essential as this helps promote venous return and decrease pain and edema; and caring and monitoring the leg cast for abnormal signs or skin changes is necessary to prevent compartment syndrome. Moreover, performing and supervising passive and active ROM promotes inflammation resolution of the damaged tissues and maintains mobility and strength of the unaffected muscles. Besides, the provision of alternative comfort plans such as massages and position changes are essential as this promotes circulation and decreases the local pressure. Encouraging the patient and providing emotional support are also important to help relieve stress and anxiety. Applying ice packs for the first three days is crucial as it decreases pain, edema, and formation of hematomas. Monitoring the catheter and urine output for any complications such as hematuria and allergies is also important. Additionally, other interventions are assessing for any signs and symptoms of infections and controlling and administering appropriate medications as indicated, such as opioids, NSAIDS, and muscle relaxants.

Risks of Foley Catheter Placement

The most common risk is urinary tract infections which can lead to orchitis or epididymitis (Shuman & Chenoweth, 2018). Other risks include bladder spasms, catheter leakage, bladder stones, hematuria, allergic reactions, urethral injury, bladder stones, and catheter dislodgement or blockage.

The Need for an Indwelling Foley Catheter

The patient still needs the indwelling Foley catheter. This is because the patient might be experiencing acute urinary retention due to medications such as anesthesia and the use of opioids (Lachance & Grobelna, 2019). Moreover, this patient might require prolonged immobilization due to the fracture and the surgery. Additionally, the patient cannot ambulate due to the fracture, and it is also essential to monitor the urine output.

References

Lachance, C. C., & Grobelna, A. (2019). Management of patients with long-term indwelling urinary catheters: a review of guidelines.

Shuman, E. K., & Chenoweth, C. E. (2018). Urinary catheter-associated infections. Infectious Disease Clinics, 32(4), 885-897.

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Directions:
You will earn points for your initial discussion post, as well as your responses. If you do not provide an initial post and responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.

Case Study Analysis

Review the case study and answer the following questions.

Case Study: Jimmy, ten years old, was admitted to the pediatric intensive care unit after a fall from the second-story townhome were sustained a fractured left femur and mild head injury. Currently, Jimmy is two days post open reduction internal fixation of the left femur. Orders were updated to transfer Jimmy out of the Intensive Care Unit (ICU) after being cleared by the neurologist. He has a long leg cast, and indwelling foley catheter and will require neuro checks every two hours.

What are two priority nursing diagnoses for this child?
What are the priority nursing interventions for this patient after being transferred from the ICU?
What are the risks of foley catheter placement?
Does the patient still require an indwelling foley catheter? Provide a rationale to support your answer.